Citalopram amplifies the influence of living conditions on mood in depressed patients enrolled in the STAR*D study

Abstract

Selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed antidepressant drugs, have a variable and incomplete efficacy. In order to better understand SSRI action, we explored the hypothesis that SSRIs do not affect mood per se but amplify the influence of the living conditions on mood. To this aim, we exploited the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) data set, selected a subpopulation of 591 patients with an overlapping clinical history and analyzed treatment outcome according to dosage −20 or 40 mg per day of citalopram. We found that sociodemographic characteristics affected treatment response in the same direction in the two dose groups, but these effects reached statistical significance only in the 40 mg per day dose group. In the latter, higher improvement rate was associated with having a working employment status (P=0.0219), longer education (P=0.0053), high income (P=0.01) or a private insurance (P=0.0031), and the higher remission rate was associated with having a working employment status (P=0.0326) or longer education (P=0.0484). Moreover, the magnitude of the effect of the sociodemographic characteristics on mood, measured as the percent of patients showing a positive outcome when exposed to favorable living conditions, was much greater—up to 37-fold—in the 40 compared to the 20 mg per day dose group. Overall, our results indicate that citalopram amplifies the influence of the living conditions on mood in a dose-dependent manner. These findings provide a potential explanation for the variable efficacy of SSRIs and might lead to the development of personalized strategies aimed at enhancing their efficacy.

iPlasticity: Induced juvenile‐like plasticity in the adult brain as a mechanism of antidepressants

“…The results of a clinical trial demonstrated that SSRI treatment combined with cognitive behavioral therapy leads to improved clinical response in SSRI‐resistant depressed adolescents . Branchi and coworkers recently showed that depressed patients living under more favorable living conditions showed a better response to citalopram than patients living under unfavorable conditions . In addition, Amin et al .…”

Benzofuran and Indole: Promising Scaffolds for Drug Development in Alzheimer's Disease

“…Among them, benzofuran‐ and indole‐based compounds are currently the subject of a great deal of attention because of their wide pharmacological applications as antiulcer, antimicrobial, anti‐inflammatory, antioxidant, antitumor, antiplatelet, antimalarial, antidepressant, and anticonvulsant agents ,–. There are several FDA‐approved drugs that have a benzofuran ring, for example, galantamine, hydrocodone, morphine, griseofulvin, saprisartan, citalopram, and many more.…”

“…[33] Among them, benzofuran-a nd indolebased compoundsa re currently the subject of ag reat deal of attention because of their wide pharmacological applications as antiulcer,a ntimicrobial, anti-inflammatory,a ntioxidant, antitumor, antiplatelet, antimalarial, antidepressant, and anticonvulsant agents. [33c,e-h] There are several FDA-approved drugs that have ab enzofuran ring, for example, galantamine, [34] hydrocodone, [35] morphine, [36] griseofulvin, [37] saprisartan, [38] citalopram, [39] and many more.Indole hasb een extensively explored for variousp harmacological activities owing to its privileged structure that can bind to multiple receptors with high affinity. [33c] An umber of marketed drugs contains the indole moiety,f or example, atevirdine, [40] indomethacin , [41] apaziquone (indolequinone), [42] and delavirdine.…”

Polymorphisms in genes related to the hypothalamic-pituitary-adrenal axis and antidepressant response – Systematic review

“…Related to this, drug-environment interactions should be considered by future research. This is important given that recent data suggest that the effect of antidepressants and psychoactive substances in general are co-determined by environmental factors, such as socioeconomic status or pre-treatment psychological state (Carhart-Harris et al, 2018;Chiarotti et al, 2017).…”